Laparoscopic restorative proctocolectomy: safety and critical level of the ileal pouch anal anastomosis

Aim The study reports the longer‐term results of laparoscopic‐assisted restorative proctocolectomy (RPC), with particular reference to safety and the level of the stapled ileal pouch‐anal anastomosis (IPAA). Method Data were collected prospectively from all patients who underwent laparoscopic RP from July 2006 to July 2010. In each patient the operation involved the use of a short (6 cm) Pfannenstiel incision to facilitate placement of the linear stapler for anorectal division. Results Seventy‐five patients underwent RPC either with total proctocolectomy (n = 53) or after previous emergency colectomy (n = 22). Early postoperative morbidity occurred in 18 (24%) patients and readmission within 30 days occurred in 18 (24%). Morbidity during follow up developed in 29 (39%). A pouchogram was carried out in all 75 patients before ileostomy closure with an abnormality shown in eight. The median level of the IPAA was at 3.0 cm (1.0–5.0cm) above the dentate line. At a median of 33 (9–57) months, there has been one case of small bowel obstruction and no incisional hernia. Conclusion In laparoscopic‐assisted RPC a limited Pfannenstiel incision allows safe construction of the IPAA at an appropriate level. Laparoscopic RPC is safe and the emerging long‐term follow‐up data show the benefitof this approach, with very low rates of small bowel obstruction and incisional hernia formation.     

腹腔镜下全结直肠切除、回肠储袋肛管吻合术治疗溃疡性结肠炎38例临床疗效分析

目的 探讨腹腔镜下行全结直肠切除、回肠储袋肛管吻合术（IPAA）治疗溃疡性结肠炎（UC）的临床疗效。方法 回顾性分析南京军区南京总医院普通外科2014年1月至2015年9月行腹腔镜下IPAA治疗的38例UC病人的术中和术后临床资料,探讨该术式的技术要点及治疗效果。结果 38例病人均成功实施 IPAA,34例病人实施腹腔镜下二期手术,4例病人实施三期手术,其中2例在第二期时中转开腹。22例为激素或挽救治疗失败的重症UC病人。手术中位时间为340（210～470）min。术后1例病人发生储袋肛管吻合口瘘,1例发生储袋顶端瘘,均经保守治疗治愈。术后3个月时随访病人平均排便次数为（4.75 ± 1.24）次/d,克利夫兰总体生活质量评价（CGQL）为0.85 ± 0.08。结论 采用腹腔镜技术行IPAA治疗UC安全可行,术后病人排便功能及生活质量满意。部分重度活动期UC病人也可实施二期手术。     

Clinical Outcomes After Restorative Proctocolectomy With Ileal Pouch Anal Anastomosis Using Ultrasonically Activated Scalpel for Ulcerative Colitis

We compared 3 different initial operative procedures performed in patients with ulcerative colitis who underwent an ileal pouch anal anastomosis (IPAA) procedure with a Harmonic Scalpel (HS). We selected 775 patients who underwent a restorative proctocolectomy with a mucosectomy using an HS and hand-sewn IPAA. Ninety-six patients underwent a total colectomy (3-stage procedure) as the initial operation, whereas 258 underwent IPAA without ileostomy (1-stage procedure) and 421 underwent IPAA with ileostomy (2-stage procedure). There were no significant differences regarding early pouch functional rate among the 3 groups. After 5 years with a functioning ileal pouch, the survival rates for the total colectomy, IPAA with ileostomy, and IPAA without ileostomy groups were 100%, 99.3%, and 99.0%, respectively. There was low operative mortality, and acceptable rates of early and late complications in patients with ulcerative colitis who underwent a restorative proctocolectomy and IPAA using an HS.     

Restorative proctectomy after emergency laparoscopic colectomy for ulcerative colitis: a case-matched study

OBJECTIVE: The aim of the study was to evaluate feasibility and safety of restorative proctectomy with ileal pouch anal anastomosis (IPAA) through a Pfannenstiel incision after prior laparoscopic colectomy. METHODS: Seventeen patients who underwent restorative proctectomy after laparoscopic emergency colectomy for ulcerative colitis (UC) were prospectively evaluated. Results were compared with results of a group of 21 case matched patients that had restorative proctectomy and IPAA via a midline incision in the same period. RESULTS: Median operation time was longer, although not significantly, in patients who had a restorative proctectomy through a pfannenstiel (186 min) compared to a restorative proctectomy through a midline incision (158 min). Procedure related complications were comparable between the groups, respectively, 1 of 17 patients in the pfannenstiel group and 3 of 21 patients in the median laparotomy group. Median hospital stay in the pfannenstiel group was 10 days and in the midline group 12 days. CONCLUSIONS: After laparoscopic assisted emergency colectomy for ulcerative colitis, restorative proctectomy is feasible and can be performed safely through a Pfannenstiel incision.     

Colectomy and ileorectal anastomosis or restorative proctocolectomy for familial adenomatous polyposis

The choice of prophylactic operation for familial adenomatous polyposis (FAP) is controversial. Colectomy and ileorectal anastomosis (IRA) is a time-honoured procedure but has recently been replaced by restorative proctocolectomy in many centres. The objective of this study was to compare the operative and functional outcomes following IRA and restorative proctocolectomy (RPC). The morbidity rate, operation time, blood loss and hospital stay were compared in 99 IRA and 33 RPC patients. The functional outcome following IRA and RPC were compared in 22 sex-matched pairs. The median hospital stay was 11 days after IRA and 12 days after RPC. The operation time was longer in RPC (216 vs 182 min) and blood loss greater (1253 vs 634 ml). The complication rates were 30% after RPC and 18% after IRA. None of 23 primary RPC operations failed, but two (20%) of the 10 patients with secondary RPC following IRA finally received a permanent ileostomy. The overall functional satisfaction was excellent in 82% and 88% after RPC and IRA, respectively. The mean basal anal pressure was higher in the IRA groups (54 vs 39 cmH₂O, P  = 0.004) and the stool frequency slightly less (4.7 vs 5.8, P  = 0.06) than after RPC. There is little difference in short-term surgical or functional results between IRA and RPC but a secondary RPC may be unsuccessful. Therefore, primary RPC may be a better option in FAP than IRA.     

Laparoscopic-assisted operation for familial adenomatous polyposis patients-two case reports.

OBJECTIVE: We describe herein the results of 2 laparoscopic operations to treat patients with familial adenomatous polyposis (FAP). METHODS: Two female FAP patients, aged 32 and 29 years old, were treated with restorative proctocolectomy and total colectomy with ileorectal anastomosis (hand-assisted laparoscopic surgery), respectively. RESULTS: The operative time was 360 minutes for the restorative proctocolectomy and 150 minutes for the total colectomy with ileorectal anastomosis. The blood loss was 500 cc for the restorative proctocolectomy and minimal for the total colectomy patient. The return of bowel movements took 3 days for each patient, and no complication occurred. Patients were discharged on the 15th and 7th postoperative days. CONCLUSION: A laparoscopic approach for restorative proctocolectomy or total colectomy with ileorectal anastomosis is safe and technically feasible, and provides good cosmesis.     

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??Laparoscopic restorative proctocolectomy and ileal pouch anal anastomosis for ulcerative colitis: An analysis of clinical outcomes in 38 patients GONG Jian-feng, WEI Yao, GU Li-li, et al. Department of General Surgery, the General Hospital of Nanjing Military Command of PLA, Nanjing 210002, China
Corresponding author: ZHU Wei-ming, E-mail: juwiming@126.com
Abstract Objective To investigate the feasibility and outcome of laparoscopic restorative proctocolectomy and ileal pouch anal anastomosis (IPAA) for ulcerative colitis (UC). Methods The clinical data of 38 patients undergoing laparoscopic IPAA in Department of General Surgery, the General Hospital of Nanjing Military Command of PLA from January 2014 to September 2015 were analyzed retrospectively, and technical notes were summarized. Results Laparoscopic IPAA was performed in 34 patients with two-stage surgery , 4 patients with three-stage surgery, and 2 patients had conversion. Twenty-two patients had acute severe UC with intravenous steroid or salvage therapy failure. Median operation time was 340 (210—470) min. Two fistulas occurred after surgery, one at pouch-anal anastomosis and one at the tip of the pouch. Both were successfully treated non-operatively. Defecation frequency 3 months after surgery was 4.75 ± 1.24 times per day. The mean Cleveland Global Quality of Life was 0.85 ± 0.08. Conclusion Laparoscopic IPAA for UC is safe and feasible, and postoperative defecation and quality of life are satisfactory. A two-stage surgery is suitable for selected patients with acute severe UC.     

Laparoscopic total colectomy for colorectal cancers: a comparative study

Background No previous report could be found in the literature comparing laparoscopic and open total colectomy for colorectal cancers, especially synchronous colorectal cancers. This study aimed to compare the short-term clinical outcomes and oncologic results of laparoscopic and open total colectomy or proctocolectomy for colorectal cancers. Methods Between July 1997 and January 2005, six patients with colorectal cancers underwent elective laparoscopic total colectomy or proctocolectomy at the authors’ institution. Clinical data for 12 patients who underwent elective open total colectomy or proctocolectomy for colorectal cancers during the same period were prospectively collected and compared. Results The median follow-up periods were 43.9 months for the laparoscopic group and 48.2 months for the open group. Conversion to open procedure was required for one patient (16.7%) in the laparoscopic group because of bleeding. The median operative time was significantly longer in the laparoscopic group (427.5 min; range, 280–480 min vs 172.5 min; range, 90–260 min; p = 0.001). The patients in the laparoscopic group required a significantly shorter duration of parenteral analgesia (3 vs 5 days; p = 0.01), but there were no differences in time to first bowel motion, time to resumption of diet, time to full ambulation, and duration of hospital stay between the two groups. Perioperative morbidity rates were comparable between the two groups, and there was no operative mortality. The oncologic results, including number of lymph nodes removed, recurrence rates, and survival rates, were similar in the two groups. Conclusions Laparoscopic total colectomy has short-term clinical outcomes (postoperative recovery and perioperative morbidity and mortality rates) and oncologic results similar to those of open surgery for treating patients with colorectal cancers. Our study has shown that the only advantage of laparoscopic over open surgery is a shorter duration of analgesic requirement, but at the expense of a longer operative time.     

Hybrid Single-incision Laparoscopic Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis for Ulcerative Colitis

Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery. We report one of the initial clinical experiences from India for Laparoscopic Restorative Proctocolectomy and Ileal Pouch Anal Anastomosis (RPC IPAA) with this new technique. A SILSTM port was used through the curved intra-umbilical 25-mm incision. A 12-mm port was placed in the right iliac fossa at the ileostomy site. Another 5 mm port was placed in the left iliac fossa at the drain site. 10 mm 0 degree lens was used through the SILS port. Two 5 mm port were placed from the SILS port. Right iliac fossa port was the surgeon’s right hand port and left hand port was 5 mm SILS port. Left iliac fossa port and 5 mm SILS port were used by the assistant surgeon for retraction. The specimen was delivered through the umbilical incision by extending the incision for 1.5 cm on either side. Ileal J Pouch was created extracorporeally and then anastomosed to the anal canal with the circular stapler laparoscopically. The diverting loop ileostomy was brought out through the right iliac fossa 12 mm port. The pelvic drain was brought out through the left iliac fossa port. The procedure was completed without any perioperative complications. Operative time was 256 minutes. Postoperative follow-up did not reveal any umbilical wound complication. Till date we have performed 26 Laparoscopic RPC with IPAA and this was the first Single Incision Laparoscopic RPC with IPAA. For experienced laparoscopic colorectal surgeons, single incision laparoscopic colectomy (SILC) is feasible. Single-incision laparoscopic colectomy is a promising alternative method as minimally invasive abdominal surgery for the treatment of patients requiring colectomy.     

Three-step ileal pouch-anal anastomosis under total laparoscopic approach for acute or severe colitis complicating inflammatory bowel disease

BACKGROUND: A two- or three-step procedure is mandatory for restorative proctocolectomy in patients presenting with severe or acute colitis complicating inflammatory bowel disease (IBD). The aim of this study was to analyze the feasibility of a total laparoscopic approach for consecutive subtotal colectomy (STC) and secondary ileal pouch-anal anastomosis (IPAA). STUDY DESIGN: All patients underwent a three-step procedure that included first, a laparoscopic STC with ileostomy and sigmoidostomy; second, a laparoscopic proctectomy and IPAA, and third, closure of the temporary ileostomy. RESULTS: Eighteen consecutive patients (7 women and 11 men), with a mean age of 39+/-14 years (range 15 to 59 years) were included. Mean lengths of the procedures were 252+/-59 minutes for STC, and 286+/-46 minutes for IPAA, respectively. Two patients (11%) after laparoscopic IPAA required conversion into laparotomy. No patient died postoperatively. Four patients had reoperations after laparoscopic IPAA for intraperitoneal hemorrhage by laparotomy (n=2) and by a transanal approach for anastomotic leakage (n=2). The overall morbidity rate was 33% (12 of 36 procedures). Mean hospital stay was 8+/-2 days after STC, and 10+/-2 days after IPAA. After a mean follow up of 13 months, all patients underwent intestinal continuity restoration. CONCLUSIONS: Our study suggests that a total laparoscopic approach is feasible and safe in inflammatory bowel disease patients with acute or severe colitis, not only for STC but also for IPAA after STC, with no mortality and an acceptable morbidity rate.     

Laparoscopic restorative proctocolectomy: a 10‐year experience of an evolving technique

Aim Restorative proctocolectomy is the definitive procedure for ulcerative colitis. The potential benefits of a minimal invasive approach make it appropriate to consider this approach provided that there are no adverse effects. The aim of the present study was to report our experience of laparoscopic assisted and ‘total’ laparoscopic restorative proctocolectomy (LRPC) and to highlight the difficulties encountered and the functional results obtained. Method Electronic data were prospectively collected from all patients who underwent laparoscopic restorative proctocolectomy (LRPC) from October 1999 to April 2010. Results Seventy‐two (40 male) patients [median body mass index 24 (19–48) kg/m²] underwent LRPC over 10 years. Three had cancer. Forty‐two had undergone a previous colectomy (laparoscopic in 38). There were 40 W‐ and 32 J‐pouch reconstructions; seven were single‐port procedures. The median operation time was 210 (75–330) min. There were five (7%) conversions, one of which resulted in immediate pouch failure. The median time to full diet was 36 (4–168) h, with a median hospital stay of 7 (2–64) days. There were seven (10%) readmissions. Complications were immediate (3%), early (22%) and long term (11%). The incidence of failure (excision or indefinite diversion) was 2.7%. The stoma has been closed in 67 patients. Median frequency of defaecation was 4/24 h, with normal continence in 90% and the ability to defer during the day in 98%. There was no new case of impotence or dyspareunia. Conclusion Laparoscopic restorative proctocolectomy is safe and gives good results when performed by an experienced laparoscopic surgeon.     

Total laparoscopic ileal pouch-anal anastomosis: prospective series of 82 patients

Background  Ileal pouch-anal anastomosis (IPAA) is the recommended procedure for ulcerative colitis and profuse familial adenomatous polyposis. The aims of this study were to report a consecutive series of 82 unselected patients who undergone a total laparoscopic IPAA with a special focus on the postoperative morbidity and 1-year functional results. Methods  Between 2002 and 2008, 82 consecutive patients undergoing IPAA under a total laparoscopic approach were enrolled. Patient data, surgical procedure, and 1-year functional outcome were analyzed. Results  Among the 82 patients, 44 (54%) had a former subtotal colectomy (STC) before IPAA. No patient died postoperatively. Conversion rate was 11%. Overall morbidity was 32%. Symptomatic anastomotic fistulas were observed in nine patients (10%). Reoperation was needed in 5/82 (6%) of the patients. One-year functional results were 4.7 ± 1.9 during the day and 1 ± 1.2 during the night. Operating time decreased significantly after the first 40 laparoscopic IPAA (p = 0.0183). No difference was observed in the morbidity and functional results between patients operated for IPAA after a former colectomy or during a restorative proctocolectomy. Conclusions  This study suggested the feasibility and safety of the total laparoscopic approach IPAA. Total laparoscopic approach could become the best approach for IPAA. Prior colectomy does not modify the result of this demanding surgical procedure.     

Laparoscopic emergency and elective surgery for ulcerative colitis

Objective To analyse surgical outcomes of fulminate and medically resistant ulcerative colitis (UC) carried out laparoscopically. Method A prospective database identified 69 consecutive patients who underwent surgery for UC under the senior author over a 5‐year period to April 2006. Results Thirty‐two patients (18 male patients), median BMI 26, underwent laparoscopic subtotal colectomy (LSTC): 22 acute emergencies, 10 refractory to medical therapy and unfit for restorative proctocolectomy. All were receiving iv steroids; azathioprine (7), cyclosporin (5). The median operation time was 135 min (65–280). There was one conversion. Twenty‐nine patients have subsequently undergone completion proctectomy and W‐pouch formation [24 patients were performed laparoscopically – laparoscopic completion proctectomy (LCP)]; widespread adhesions precluded in five patients. Twenty‐six patients underwent restorative laparoscopic proctocolectomy (LRP) – one conversion. Twenty patients underwent W‐pouch reconstruction via a Pfannenstiel incision. Six J‐pouches were constructed and returned via the ileostomy site. Three underwent a laparoscopic pan‐proctocolectomy (LPPC); one conversion. Eight patients underwent open STC. The median time to normal diet was 48 h (1–7 days) for LSTC/LCP and 36 h (1–5 days) for LRP. There were two major complications following LRP, two following LSTC, one following LCP, one following LPPC and five following open surgery. Median hospital stay was 8 days (6–72) for LSTC, 7 days (6–9) for LCP and 5 days (3–45) for LRP. There were six 30‐day readmissions following laparoscopic surgery (DVT, reactive depression, ileostomy hold up (2), abdominal pain and high output ileostomy). Conclusion Laparoscopic subtotal and restorative proctocolectomies in fulminate and medically resistant UC are feasible, safe and largely predictable operations that allow for early hospital discharge. Laparoscopic colectomy facilitates subsequent proctectomy and pouch construction.     

Laparoscopic total proctocolectomy with ileal pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis: initial experience in Mexico

Background Since the introduction of laparoscopic colectomy in 1991, experience in laparoscopic bowel surgery has gradually increased. Several reports from specialized centers have demonstrated that laparoscopic colorectal resections are feasible and safe, providing an acceptable alternative to laparotomy for a variety of diseases. Some studies have shown the feasibility, safety, and good functional outcome of the minimally invasive procedures for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). No known studies have investigated laparoscopic proctocolectomy in México. This report aims to describe the first laparoscopic proctocolectomies with ileal pouch anal anastomosis (IPAA) performed at the Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán (INCMNSZ). Methods All the patients in the authors’ institution who underwent a one- or two-stage laparoscopic total proctocolectomy with IPAA between June 2005 and December 2006 were included in the study. All the operations were performed by the same surgeon, who had already completed the learning curve for colorectal laparoscopic procedures. Results For the study, 10 patients underwent a laparoscopic proctocolectomy with IPAA by a single surgeon. Eight of the patients underwent a one-stage procedure, whereas two patients with severe colitis underwent a two-step procedure. All the cases were managed with a diverting loop ileostomy. Six patients underwent a standard double-stapled IPAA anastomosis, and two patients with FAP underwent a mucosectomy with a manual IPAA anastomosis. The mean operative time was 187 min, and the mean blood loss was 46 ml. There were two postoperative complications. One patient presented with an early small bowel obstruction due to an internal hernia, which required reoperation. The other complication was a wound infection. The mean return to oral intake was 1.5 days, and the mean length of hospital stay was 3.4 days. Conclusion Although this was not a comparative study and although sample size imposed limitations, with this preliminary data, we conclude that the laparoscopic approach to UC and FAP at our institution is safe, feasible, and effective. However, to achieve the benefits in postoperative outcome, this procedure should be performed only by experienced laparoscopic surgeons.     

腹腔镜全结肠加部分直肠切除回直肠吻合术治疗混合型便秘25例疗效分析

目的 探讨腹腔镜全结肠加部分直肠切除回直肠吻合术治疗混合型便秘的有效性及安全性。方法 回顾性分析2020年1月至2021年1月上海交通大学医学院附属瑞金医院收治的符合手术指征的25例混合型便秘病人的临床资料,均行腹腔镜全结肠加部分直肠切除回直肠吻合术。随访观察病人术后胃肠道功能恢复情况、术后并发症、住院时间、病人满意度、便秘症状改善情况及心理状态。结果 所有25例病人均顺利完成手术,术后首次排气时间为（49.9±16.5）h,首次排便时间为（66.2±26.6）h,住院时间（9.2±4.7）d。术后病人恢复排便后呈现不同程度的大便次数增加,为（13.8±9.3）次/d。术后6个月逐步改善至（5.2±3.9）次/d,术后1年为（3.8±4.5）次/d。病人满意度为（85.3±27.9）分,便秘治疗有效率为92.0%。部分便秘病人术后仍合并焦虑和（或）抑郁状态,便秘复发病人中焦虑和（或）抑郁人群的比例明显高于便秘缓解病人,差异有统计学意义（P＜0.05）。结论 腹腔镜全结肠加部分直肠切除回直肠吻合术治疗混合型便秘安全、可行,病人术后恢复快。     

A cohort study of results following elective colonic and rectal resection within an enhanced recovery programme

Objective  The use of laparoscopic surgery coupled with an enhanced recovery programme (ERP) has resulted in hospital stays of 4 or less days for colonic and 6 days following rectal resection, in previously reported small selected groups of patients. This report analyses an unselected cohort to determine if such benefits are reproducible.
Method   Consecutive patients undergoing elective colonic or rectal surgery at a single centre between January 2002 and January 2006 were followed. All were included in the ERP and underwent either laparoscopic or open surgery.
Results   The study group comprised 241 patients (mean age of 67 ± standard deviation 14 years and 49% male sex distribution) who underwent elective colorectal resection within the context of an ERP. One hundred and fifty-one (62.7%) patients had malignant disease. Overall, 191 (79.3%) patients underwent a laparoscopic procedure and the remaining underwent an open operation. Postoperative stay was shorter in patients undergoing laparoscopic vs open, colonic surgery (4 days vs 6 days, P  = 0.002). A nonsignificant trend towards reduced postoperative stay was observed for patients undergoing laparoscopic vs open, rectal surgery (6 days vs 9 days, P  = 0.088). Patients undergoing laparoscopic colectomy demonstrated significantly lower 30-day mortality rates than those undergoing traditional colectomy (3/131 vs 3/39, P  = 0.049).
Conclusion  Laparoscopic colonic surgery in the context of an ERP offers reduced hospital stay and may confer a survival advantage over traditional techniques. These results confirm that previously reported benefits of laparoscopic surgery are reproducible within an unselected population.     

Laparoscopic Surgery for Patients with Crohn’s Colitis: A Case-matched Study

Introduction The purpose of this study was to compare short and long-term outcomes of laparoscopic colectomy with open colectomy in patients with Crohn’s disease confined to the colon. Materials and Methods We reviewed all patients undergoing laparoscopic colectomy for Crohn’s disease at our institution between 1994 and 2005. Laparoscopic colectomies were matched to open colectomies by patient age, gender, American Society of Anesthesiologists score, type, and year of surgery. We excluded patients with concomitant small bowel disease. Results Twenty-seven laparoscopic cases were matched with 27 open cases. There were seven conversions (26%). There was no mortality. Median operative times were significantly longer after laparoscopic colectomy (240 vs 150 min, P < 0.01), and estimated blood loss was comparable (325 vs 350 ml, P = 0.4). Postoperative complications were similar. Laparoscopic colectomies had shorter median length of stay (5 vs 6 days, P = 0.07) and median time to first bowel movement (3 vs 4 days, P = 0.4). When overall length of stay included 30-day readmissions, the difference in favor of laparoscopy became statistically significant (P = 0.02). Recurrent disease requiring surgery was decreased after laparoscopy, although median follow-up was significantly shorter. Conclusion Laparoscopic colectomy is a safe and acceptable option for patients with Crohn’s colitis. Longer follow-up is needed to accurately establish recurrence rates.     

Timing of restorative proctectomy following subtotal colectomy in patients with inflammatory bowel disease

BACKGROUND: There is no general consensus regarding the timing of restorative proctocolectomy (RPC) in patients who have undergone subtotal colectomy with end ileostomy (STC). The aim of this study was to determine the impact of timing of RPC in patients who have undergone subtotal colectomy and end ileostomy for inflammatory bowel disease (IBD). METHODS: A retrospective medical record review of patients who had undergone RPC after STC was undertaken. Patients were divided into 3 groups according to timing of the completion proctectomy: 7 months. RESULTS: From 1990 to 2000, 91 patients had undergone RPC after STC for IBD. There were no statistically significant differences among the three groups relative to mean age, gender, final diagnosis, duration of disease, body mass index, comorbidity, extraintestinal manifestations, use of immunuosuppressives, or operative time. The number of intra-operative complications were significantly higher in the 相似文献   

Laparoscopic surgery for ulcerative colitis – a meta-analysis

OBJECTIVE: To assess the safety and feasibility of laparoscopic surgery for patients with ulcerative colitis. METHODS: A search of published studies in English between January 1992 and September 2005 was obtained, using the MEDLINE and PubMed databases and the Cochrane Central Register of Controlled Trials. Two independent assessors reviewed the studies using a standardized protocol. Where raw data, means and standard deviations were available, meta-analysis was performed using the Forest plot review. Studies where medians and ranges were presented were separately analysed. RESULTS: The duration of surgery for laparoscopic and open procedures were similar (weighted mean difference 62.92 min, P = 0.19). Patients were able to tolerate oral intake significantly earlier, with a weighted mean difference of 1.39 days (P = 0.002), but recovery of bowel function was similar (weighted mean difference 0.73 days, P = 0.36). The length of hospital stay was shorter for patients who had undergone laparoscopic surgery, with a weighted mean difference of 2.64 days (P = 0.003). The complication rate was higher in open colectomy, compared to laparoscopic colectomy (67.6%vs 39.7%, P = 0.005). For restorative proctocolectomy, complication rates were comparable between the laparoscopic and open groups (P = 0.25). CONCLUSIONS: The time taken to perform laparoscopic surgery is similar to open surgery. Patients are able to tolerate oral intake earlier, and have a shorter hospitalization. Laparoscopic colectomy was safer compared to the open procedure, but both were equally safe for patients who had restorative proctocolectomy. Thus, laparoscopic surgery for ulcerative colitis is both safe and feasible.     

V4Total laparoscopic restorative proctocolectomy for ulcerative colitis

Introduction:  Laparoscopic ileal pouch-anal anastomosis (IPAA) has been shown to be a safe and feasible technique for patients with ulcerative colitis refractory to medical management and familial polyposis. We aim to demonstrate our technique of total laparoscopic proctocolectomy with intracorporeal pouch-anal anastomosis with specific reference to intaroperative tricks of the trade.
Patient and Methods:  The patient is a 16-year-old male with ulcerative colitis. The video demonstrates a total laparoscopic proctocolectomy and formation of a (J) ileal pouch anal anastomosis. A standard colonic mobilisation of the colon was performed with the use of the Goldfinger retractor to aid vessel division and the use of the harmonic scalpel for mesenteric division apart from the transverse mesocolon where the ligasure was employed. The right colon was only mobilised after complete mesenteric division of the left & transverse colon to prevent looping. The rectum, once mobilised to the pelvic floor, was divided in the AP direction with the endoGIA. Techniques to prevent twisting of the pouch and inadvertent twisting of the proximal small bowel are demonstrated. The video also highlights the importance of positioning the patient and use of 0 and 30 degree scopes. A technique to tackle a defect in the anal stump is also described.
Conclusion:  The technique of laparoscopic IPAA adheres to the principles of open pouch surgery but we await the development of more suitable laparoscopic staplers to aid the clinician in division of the anorectal junction.